decisionhealth Newsletters, Part B News - 2012 Issue 2 (February)
How to leave a lousy payer and secure revenue in the process
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Article Overview
This article explains how medical practices can assess the financial impact of ending a payer relationship after difficult contract negotiations. It is aimed at practice managers and billing leaders who want a high-level framework for analyzing revenue, expenses, patient volume, transition planning, and contract termination communications. The piece presents broad guidance on preparation, patient notice, continuation-of-care considerations, and the business tradeoffs involved in leaving a low-paying payer.
Why This Topic Matters
For practices under pressure from unfavorable contract terms, the article highlights the business planning needed before terminating a payer. It helps readers understand the operational and revenue implications of making that decision.
Article Sections
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Contract negotiations
Introduces the article’s focus on preparing for payer contract disputes and the business context surrounding contract termination decisions.
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Six steps to take when deciding whether leaving a payer is financially beneficial to your practice
Outlines a step-by-step framework for evaluating the financial impact of ending a payer relationship, including revenue, costs, volume changes, patient notice, and follow-up considerations.
What You Will Learn
- How the article frames the decision to leave a payer contract
- What types of financial analysis are discussed before terminating a contract
- What operational topics are covered when planning a payer exit
- How the article addresses patient notification and transition planning
- Why the article treats contract termination as a broader business decision
Who Should Read This
- Practice administrators
- Billing managers
- Revenue cycle staff
- Physician owners
- Healthcare consultants
Codes Discussed
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